Chapter 28: Psychosocial interventions to support carers

Case Study: The risk of family members developing mental health problems

Justine is a 29-year-old woman whose father (Lloyd) was diagnosed with a psychotic illness when she was seven years old. Her father and mother separated shortly after Justine was born and she was raised by her mother and stepfather in what she described as a happy childhood. Justine had limited contact with her father through her childhood but over the past five years re-established contact with Lloyd usually through social media or a phone conversation once or twice a month while four or five times a year they met in person. In the past year, Lloyd became quite unwell and this necessitated a period of inpatient treatment. This was the first time that Justine had become aware of the disabling nature of Lloyd’s illness and the changes to his personality and behaviour when he was unwell. Justine found this difficult to deal with and did not visit Lloyd nor contact him when he was an inpatient. It was only after Justine was contacted by Lloyd after he was discharged to a supported hostel that she started to have contact with him once more. The deterioration in Lloyd’s health coincided with her announcement that she had become engaged to be married. Justine contacted Lloyd’s community nurse and asked whether she could meet with her. Lloyd was aware the meeting was taking place and had stated he was happy for information about his mental health history to be shared with Justine. When Justine met with the community nurse she initially expressed her concern and fright as to how Lloyd had acted when unwell. Justine also wanted to discuss not having children once she was married as she could not cope with bringing children into the world who would become mentally unwell.

  • How would you respond to Justine’s comments about being concerned and frightened when Lloyd was unwell?
  • What would you say to Justine when she starts the discussion about not wanting to have children because of the risk that they may develop mental health problems?

› Possible answer

Possible answer to: How would you respond to Justine’s comments about being concerned and frightened when Lloyd was unwell?

  • Allow Justine space to talk about her experiences and her fears.
  • Look at areas of concern and examine specific instances when Justine was concerned or frightened.
  • Examine Justine’s responses to these events and explore coping responses. This would include developing strategies as to how Justine responds to Lloyd when he is unwell and looking at when and how she would liaise with the local mental health team particularly in relation to any crisis.
  • Convene family meetings between Lloyd and Justine with a family worker to allow Justine to describe her concerns. This would also allow Lloyd to be both aware of these concerns and give him a chance to respond.
  • Provide Justine information about mental health, the reasons how mental health problems develop, and how mental health problems present in individuals’ thoughts and behaviours.
  • Give information about support services that are provided by local mental health services as well as those provided by voluntary and charitable groups.

 

Possible answer to: What would you say to Justine when she starts to discuss not wanting to have children because of the risk they may develop mental health problems?

It would be helpful to allow Justine to discuss her concerns about having children and the potential that her children may develop mental health problems. Throughout the discussion it is important to recognise Justine’s concerns, not to give one’s own opinion, and be clear that this decision would be made by Justine (and her fiancé). It would also be important to ensure that Justine receives up to date information about the risks of a child developing mental health problems if a grandparent is diagnosed with a mental illness. There would need to be some acknowledgment of the increased risk of Justine’s children developing mental health problems. Rethink (2015) report that suggest that a child with one parent diagnosed with schizophrenia has about a 13% risk of developing schizophrenia compared to a 1% risk in the general population while a child of a bipolar parent has a 15% risk of developing mental health problems as oppose to 2–3% of the general population. The risk is reduced for a child if a ‘second degree relative’ has the condition to 3% for grandchildren of someone diagnosed with schizophrenia and 5% for bipolar disorder. The stress vulnerability model might be a useful way to examine with Justine the factors that influence the development of mental health problems. The model suggests that people may have inherited an increased genetic predisposition to a serious mental health problem from a family member. However, this predisposition does not mean that a child will develop mental health problems and that other individual characteristics as well as environmental stressors also influence the development of mental health problems. It may also be helpful to note that individuals living in what is considered a ‘low-risk’ environment for developing mental health problems is protective for those with either high or low genetic risk. If appropriate, it may be helpful to refer Justine to a specialist in genetic counselling.

Reference

Rethink (2015) Does mental illness run in families? Factsheet (Version 5). Rethink, London. (https://www.rethink.org/resources/d/does-mental-illness-run-in-families-...)